A term boy born to a mother with insulin-dependent pregestational diabetes
has a bedside capillary glucose of 32 mg/dL at 1 hour of life. He is awake and
has normal vital signs. Which of the following is the most appropriate next
step in management?
- A. Instruct the mother to breast-feed him and recheck the glucose in 30 minutes.
- B. Place an IV and administer glucose.
- C. Recheck the glucose in 1 hour.
- D. Measure his serum insulin level.
- E. Take him to the nursery for observation.
A. Infants of diabetic mothers are at risk for hypoglycemia and should feed
within the first hour of birth and glucose should be measured 30 minutes later.
In this infant’s case, he has not fed yet, so he should breast-feed and have the
glucose remeasured. IV glucose would be needed at this time only if he has
symptoms of hypoglycemia. Rechecking the glucose in an hour without feeding is withholding treatment and not appropriate; the latter choices also do not
include providing the appropriate treatment